By the time Thomas got down to OR 18, the Dexedrine had cleared his head. He considered scrubbing right away but then decided it was better to find out first what he was up against.
The residents were standing around the anesthetized patient, their gloved hands resting within the sterile field. The scene did not look auspicious.
“What’s the…” began Thomas, his voice hoarse. He hadn’t spoken since awakening except for the few words to the nurse. He cleared his throat. “What’s the problem?”
“You were right about the hemopericardium,” said Peter with respect. “The knife penetrated the pericardium and cut the surface of the heart. There’s no bleeding, but we wondered if we should close the laceration.”
Thomas had the circulation nurse locate a stool and put it behind Peter. From that vantage point, he could see into the incision. Peter pointed to the laceration and bent to the side.
Thomas was relieved. The laceration was inconsequential, having missed any significant coronary vessels.
“Just leave it as is,” said Thomas. “The marginal benefits of suturing it aren’t worth the possible problems the suture might cause.”
“Good enough,” said Peter.
“Leave the pericardium open, too,” warned Thomas. “It will reduce the chances of running into a problem with tamponade in the postoperative course. It will serve as a drainage point if there is any bleeding.”
An hour later Thomas crossed from the hospital to the Professional Building. When he entered his office he felt unpleasantly wired from the Dexedrine. Over and over he kept worrying about Ballantine and Sherman’s presence in the hospital that night. It was obvious they were having some kind of secret meeting, and, as he wondered what they were plotting, he felt his anxiety mount. Now he knew he would be unable to sleep unless he took something.
He rarely got such a surge from a single Dexedrine but decided it was probably due to his general exhaustion. Going over to his desk, he gobbled another Percodan. Then, fearful that he might have trouble waking up in the morning, Thomas called Doris. He had to let the phone ring a long time. Mentally he retraced the complicated route from her bed to the phone by the bay window. He wondered why she didn’t get an extension.
“Listen,” said Thomas when she answered. “You’ve got to come into the office at six-thirty.”
“That’s only a couple hours from now,” protested Doris.
“Jesus Christ,” shouted Thomas angrily. “You don’t have to tell me what time it is. Don’t you think I know? But I have three bypasses starting at seven-thirty. I want you over here to make sure I’m up.”
Thomas slammed the phone down in its cradle, seething. “Goddamn selfish bitch,” he said out loud as he punched his pillow into submission.
Seven
Cassi’s eyes blinked open. It was a little after five in the morning and was not yet light outside. The alarm wasn’t scheduled to go off for another two hours.
For a while she lay still, listening. She thought perhaps some sound had awakened her but as the minutes passed, she realized that the disturbance had come from within her head. It was the classical symptom of depression.
At first Cassi tried turning over and drawing the covers up over her head, but she soon recognized it was useless. She couldn’t go back to sleep. She got out of bed, knowing full well that she would be exhausted that day, especially since Thomas had made her accept an invitation to go to the Ballantines that evening.
The house was frigid, and she was shivering before she got on her bathrobe. In the bathroom she turned on the quartz heater and started the shower.
Stepping under the water, Cassi reluctantly allowed herself to remember the reason for her depression-the discovery of the Percodan and the Talwin in Thomas’s desk. And Patricia was undoubtedly going to inform her son that Cassi had again been snooping in his study. Thomas would guess that she’d been looking for drugs.
Getting out of the shower, Cassi tried to decide what to do. Should she admit she’d found the drugs and confront him? Was the presence of the drugs sufficiently incriminating? Could there be another explanation for their presence in Thomas’s desk? Cassi doubted it, considering the additional fact of Thomas’s frequently pinpointed pupils. As much as Cassi did not want to believe it, Thomas was most likely taking the Percodan and Talwin. How much, Cassi had no idea. Nor did she have any idea how much she was to blame.
The thought occurred to Cassi that maybe she should seek help. But who to turn to? She had no idea. Patricia obviously wasn’t the answer, and if she went to any of the authorities, then Thomas’s career could be ruined. Cassi felt almost too depressed to cry. It was a no-win situation. No matter what she did or didn’t do, it was going to cause trouble. Lots of trouble. Cassi was aware that her relationship with Thomas could very well be at stake.
It took all her strength to finish getting ready for work and make the long drive to the hospital.
Cassi had no more than dumped her canvas bag on her desk when Joan’s head came through the door.
“Feeling any better?” asked Joan brightly.
“No,” said Cassi in a tired, flat voice.
Joan could sense her friend’s depression. From a professional point of view she knew Cassi was worse than she’d been the previous afternoon. Unbidden, Joan came into Cassi’s office and closed the door. Cassi didn’t have the energy to object.
“You know the old aphorism about the sick doctor,” said Joan: “ ‘He who insists on taking care of himself learns he has a fool for a patient.’ Well, that applies in the emotional realm as well. You don’t sound so good to me. I came in here to apologize for foisting my opinions on you yesterday, but looking at you now, I think it was the right thing to do. Cassi, what’s happening to you?”
Cassi was immobilized.
There was a knock on the door.
Joan opened it and confronted a tearful Maureen Kavenaugh.
“Sorry, Dr. Cassidy is occupied,” said Joan. She closed the door in Maureen’s face before the woman could respond.
“Sit down, Cassi,” said Joan firmly.
Cassi sat down. The idea of forceful direction was appealing.
“Okay,” said Joan. “Let’s hear what’s going on. I know you have your hands full with your eye problem. But it’s more than that.”
Once again Cassi recognized the seductive pressure of the psychiatric interview on the patient to talk. Joan inspired confidence. There was no doubt about that. And Cassi could be assured of confidentiality. And in the last analysis Cassi desperately wanted to share her burden with someone. She needed some insight if not merely support.
“I think Thomas is taking drugs,” said Cassi in a voice so low Joan could barely hear. She watched Joan’s face for the expected signs of shock, but there weren’t any. Joan’s expression didn’t change.
“What kind of drugs?” asked Joan.
“Dexedrine, Percodan, and Talwin are the ones I know of.”
“Talwin is very common among physicians,” said Joan. “How much is he taking?”
“I don’t know. As far as I am aware, his surgery hasn’t suffered in the slightest. He’s working as hard as ever.”
“Uh huh,” nodded Joan. “Does Thomas know you know?”
“He knows I suspect the Dexedrine. Not the others. At least not yet.” Cassi wondered how soon Patricia would tell Thomas she’d been in his study.
“There’s a euphemistic term for this,” said Joan. “It’s called the ‘impaired physician.’ Unfortunately it is not all that uncommon. Maybe you should read up on it; there’s a lot of material in the medical literature although doctors themselves usually hate to confront the problem. I’ll give you some reprints. But tell me, has Thomas exhibited any of the associated behavioral changes-like embarrassing social behavior or disruption of his appointment schedule?”